1619148293 NPI number — JOSE EDGARDO VALERIO MD

Table of content: JOSE EDGARDO VALERIO MD (NPI 1619148293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619148293 NPI number — JOSE EDGARDO VALERIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALERIO
Provider First Name:
JOSE
Provider Middle Name:
EDGARDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VALERIO-PASCUA
Provider Other First Name:
JOSE
Provider Other Middle Name:
EDGARDO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619148293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 565338
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33256-5338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-218-4128
Provider Business Mailing Address Fax Number:
786-363-1179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6129 SW 70TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33143-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-871-6800
Provider Business Practice Location Address Fax Number:
786-871-6801
Provider Enumeration Date:
03/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  ME108682 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003012400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110623900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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